{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:53:44Z","timestamp":1781502824869,"version":"3.54.1"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sleep problems impact over 65% of patients with multiple sclerosis (MS), a prevalence significantly greater than that observed in the general population. This study aimed to assess the frequency and risk-associated factors of sleep problems in a large MS cohort and evaluate their impact on quality of life (QoL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study included 103 participants with MS across different disease stages and 62 healthy controls. Assessment tools included the Expanded Disability Status Scale (EDSS), Pittsburgh Sleep Quality Index (PSQI), depression and fatigue scales, 9-Hole Peg Test, 25-foot walk test, cognitive function assessments, and QoL measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sleep problems were significantly more frequent in MS patients (68.9%) than in controls (30.6%). PSQI scores showed positive correlations with the number of MS relapses across the course of disease duration, walking impairment, fatigue and depression scores. Sleep problems were determined to adversely affect various domains of quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings demonstrate that sleep problems are remarkably common among patients with MS. Patients experiencing poor sleep quality are typically associated with higher levels of fatigue, depression, greater difficulty with mobility, and more frequent disease relapses. These sleep problems significantly impaired the overall QoL in MS patients. A multidisciplinary approach is therefore essential for managing sleep disorders in MS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1563041","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T04:11:32Z","timestamp":1745986292000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Frequency and risk factors of sleep problems in Egyptian patients with multiple sclerosis"],"prefix":"10.3389","volume":"16","author":[{"given":"Eman M.","family":"Khedr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gellan K.","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shady Safwat","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Nageh","family":"Foly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motez Mahmoud","family":"Attia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A.","family":"Karim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nourelhoda A.","family":"Haridy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/S0140-6736(18)30481-1","article-title":"Multiple sclerosis","volume":"391","author":"Thompson","year":"2018","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.smrv.2009.07.005","article-title":"Sleep disorders in patients with multiple sclerosis","volume":"14","author":"Brass","year":"2010","journal-title":"Sleep Med Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s11325-016-1416-y","article-title":"Sleep disorders in patients with multiple sclerosis in China","volume":"21","author":"Ma","year":"2017","journal-title":"Sleep Breath"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1055\/s-2005-867075","article-title":"Sleep disorders in multiple sclerosis","volume":"25","author":"Fleming","year":"2005","journal-title":"Semin Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/B978-0-323-91532-8.00013-6","article-title":"Multiple sclerosis and related disorders","volume":"189","author":"Kimoff","year":"2022","journal-title":"Handb Clin Neurol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.nrl.2021.03.012","article-title":"Sleep disorders in patients with multiple sclerosis in Spain","volume":"39","author":"Zhang","year":"2024","journal-title":"Neurologia"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1191\/135248506ms1320oa","article-title":"Sleep and fatigue in multiple sclerosis","volume":"12","author":"Stanton","year":"2006","journal-title":"Mult Scler J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1136\/jnnp-2022-330123","article-title":"Insufficient sleep during adolescence and risk of multiple sclerosis: results from a Swedish case-control study","volume":"94","author":"\u00c5kerstedt","year":"2023","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"271","DOI":"10.3390\/ijerph19063271","article-title":"Sleep disturbances, degree of disability and the quality of life in multiple sclerosis patients","volume":"19","author":"Ko\u0142tuniuk","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s11325-022-02653-8","article-title":"The importance of assessing sleep disorders in multiple sclerosis","volume":"27","author":"Kondo","year":"2023","journal-title":"Sleep Breath"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav Res Methods"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*power 3.1: tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav Res Methods"},{"key":"ref13","first-page":"17","article-title":"Sleep quality in patients with multiple sclerosis","volume":"3","author":"Mosarrezaii","year":"2018","journal-title":"J Sleep Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1177\/1352458517727603","article-title":"Safety and efficacy of cladribine tablets in patients with relapsing-remitting multiple sclerosis: results from the randomized extension trial of the CLARITY study","volume":"24","author":"Giovannoni","year":"2018","journal-title":"Mult Scler"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","article-title":"Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS)","volume":"33","author":"Kurtzke","year":"1983","journal-title":"Neurology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/1471-2377-14-58","article-title":"Systematic literature review and validity evaluation of the expanded disability status scale (EDSS) and the multiple sclerosis functional composite (MSFC) in patients with multiple sclerosis","volume":"14","author":"Meyer-Moock","year":"2014","journal-title":"BMC Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1191\/1352458505ms1117oa","article-title":"Evaluation of the modified fatigue impact scale in four different European countries","volume":"11","author":"Kos","year":"2005","journal-title":"Mult Scler"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.4102\/ajod.v13i0.1376","article-title":"The impact of fatigue on people with multiple sclerosis in Morocco","volume":"13","author":"Lotfi","year":"2024","journal-title":"Afr J Disabil"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1177\/2055217319887987","article-title":"Assessing fatigue in multiple sclerosis: psychometric properties of the five-item modified fatigue impact scale (MFIS-5)","volume":"5","author":"Meca-Lallana","year":"2019","journal-title":"Mult Scler J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.psychres.2010.12.007","article-title":"Reliability of the Hamilton rating scale for depression: a meta-analysis over a period of 49 years","volume":"189","author":"Trajkovi\u0107","year":"2011","journal-title":"Psychiatry Res"},{"key":"ref24","volume-title":"SF-36 health survey: manual and interpretation guide","author":"Ware","year":"1993"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"5656","DOI":"10.1002\/sim.7085","article-title":"Methods for assessing the reliability of quality of life based on SF-36","volume":"35","author":"Pan","year":"2016","journal-title":"Stat Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.rehab.2012.05.003","article-title":"Translation in Arabic, adaptation and validation of the SF-36 Health survey for use in Tunisia","volume":"55","author":"Guermazi","year":"2012","journal-title":"Ann Phys Rehabil Med"},{"key":"ref27","first-page":"77","article-title":"Hand strength and dexterity","volume":"25","author":"Kellor","year":"1971","journal-title":"Am J Occup Ther"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1177\/153944928500500102","article-title":"Adult norms for the nine hole peg test of finger dexterity","volume":"5","author":"Mathiowetz","year":"1985","journal-title":"Occupat Ther J Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1177\/1352458517690824","article-title":"The nine-hole peg test as a manual dexterity performance measure for multiple sclerosis","volume":"23","author":"Feys","year":"2017","journal-title":"Mult Scler"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/MRR.0000000000000209","article-title":"Reliability, precision, and clinically important change of the nine-hole peg test in individuals with multiple sclerosis","volume":"40","author":"Hervault","year":"2017","journal-title":"Int J Rehabil Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"102512","DOI":"10.1016\/j.autrev.2020.102512","article-title":"Clinical outcome measures in multiple sclerosis: a review","volume":"19","author":"Inojosa","year":"2020","journal-title":"Autoimmun Rev"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1177\/1352458517690823","article-title":"Validity of the timed 25-foot walk as an ambulatory performance outcome measure for multiple sclerosis","volume":"23","author":"Motl","year":"2017","journal-title":"Mult Scler J"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1177\/13524585211017013","article-title":"The timed 25-foot walk in a large cohort of multiple sclerosis patients","volume":"28","author":"Kalinowski","year":"2022","journal-title":"Mult Scler J"},{"key":"ref34","volume-title":"CVLT: California verbal learning test-adult version: Manual","author":"Delis","year":"1987"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"103432","DOI":"10.1016\/j.msard.2021.103432","article-title":"Circulatory antioxidant and oxidative stress markers are in correlation with demographics but not cognitive functions in multiple sclerosis patients","volume":"57","author":"Naseri","year":"2022","journal-title":"Mult Scler Relat Disord"},{"key":"ref36","volume-title":"Brief visuospatial memory test-revised","author":"Benedict","year":"1997"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"105180","DOI":"10.1016\/j.msard.2023.105180","article-title":"Thalamic atrophy, duration of illness, and years of education are the best predictors of cognitive impairment in multiple sclerosis","volume":"80","author":"Khedr","year":"2023","journal-title":"Mult Scler Relat Disord"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/1471-2377-12-55","article-title":"Brief international cognitive assessment for MS (BICAMS): international standards for validation","volume":"12","author":"Benedict","year":"2012","journal-title":"BMC Neurol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s41983-021-00303-6","article-title":"Reliability and validity of Arabic version of the brief international cognitive assessment for multiple sclerosis: Egyptian dialect","volume":"57","author":"Farghaly","year":"2021","journal-title":"Egypt J Neurol Psychiatry Neurosurg"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1136\/jnnp-2022-329227","article-title":"Poor sleep and multiple sclerosis: associations with symptoms of multiple sclerosis and quality of life","volume":"93","author":"Laslett","year":"2022","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e49996","DOI":"10.1371\/journal.pone.0049996","article-title":"Poor sleep in patients with multiple sclerosis","volume":"7","author":"B\u00f8e Lunde","year":"2012","journal-title":"PLoS One"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7224\/1537-2073.2014-046","article-title":"Fatigue, sleep quality, and disability in relation to quality of life in multiple sclerosis","volume":"17","author":"Tabrizi","year":"2015","journal-title":"Int J MS Care"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.dhjo.2014.05.004","article-title":"Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration","volume":"7","author":"Vitkova","year":"2014","journal-title":"Disabil Health J"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s12529-017-9653-4","article-title":"Factors associated with poor sleep in older adults with multiple sclerosis","volume":"24","author":"Garland","year":"2017","journal-title":"Int J Behav Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"553","DOI":"10.5664\/jcsm.4702","article-title":"Sleep disorders in patients with multiple sclerosis","volume":"11","author":"\u010carnick\u00e1","year":"2015","journal-title":"J Clin Sleep Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.sleep.2008.02.002","article-title":"Importance of sleep in the quality of life of multiple sclerosis patients: a long under-recognized issue","volume":"10","author":"Attarian","year":"2009","journal-title":"Sleep Med"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1177\/1352458511432328","article-title":"Obstructive sleep apnea is associated with fatigue in multiple sclerosis","volume":"18","author":"Kaminska","year":"2012","journal-title":"Mult Scler"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"S82","DOI":"10.1016\/j.clineuro.2013.09.028","article-title":"Pathophysiological background and clinical characteristics of sleep disorders in multiple sclerosis","volume":"115","author":"Barun","year":"2013","journal-title":"Clin Neurol Neurosurg"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3389\/fneur.2015.00021","article-title":"Fatigue in multiple sclerosis: a look at the role of poor sleep","volume":"6","author":"Strober","year":"2015","journal-title":"Front Neurol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"2055217319895540","DOI":"10.1177\/2055217319895540","article-title":"Multiple sclerosis in the Middle East and North Africa region","volume":"6","author":"Khoury","year":"2020","journal-title":"Mult Scler J"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1159\/000470904","article-title":"Sleep disorder as a triggering factor for relapse in multiple sclerosis","volume":"77","author":"Sahraian","year":"2017","journal-title":"Eur Neurol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"203","DOI":"10.3934\/medsci.2016.2.203","article-title":"Factors associated with sleep quality in patients with multiple sclerosis","volume":"3","author":"Kara","year":"2016","journal-title":"AIMS Med Sci"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e00553","DOI":"10.1002\/brb3.553","article-title":"Poor sleep quality in patients with multiple sclerosis: gender differences","volume":"6","author":"Vitkova","year":"2016","journal-title":"Brain Behav"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.sleep.2007.11.004","article-title":"Prevalence of \u2018poor sleep\u2019 among patients with multiple sclerosis: an independent predictor of mental and physical status","volume":"10","author":"Merlino","year":"2009","journal-title":"Sleep Med"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/j.1600-0404.2004.00257.x","article-title":"Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality","volume":"110","author":"Lobentanz","year":"2004","journal-title":"Acta Neurol Scand"},{"key":"ref56","first-page":"1582","article-title":"Relationship between sleep quality and quality of life in patients with multiple sclerosis","volume":"5","author":"Sarraf","year":"2014","journal-title":"Int J Prev Med"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1080\/15402002.2016.1173555","article-title":"Is poor sleep quality associated with greater disability in patients with multiple sclerosis?","volume":"16","author":"Vitkova","year":"2018","journal-title":"Behav Sleep Med"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1007\/s00415-010-5684-3","article-title":"Fatigue, sleepiness, and physical activity in patients with multiple sclerosis","volume":"258","author":"Merkelbach","year":"2011","journal-title":"J Neurol"},{"key":"ref59","first-page":"704","article-title":"Sleep disorders in multiple sclerosis","volume":"19","author":"Alarcia","year":"2004","journal-title":"Neurologia"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"66","DOI":"10.18502\/cjn.v21i2.10489","article-title":"Sleep status in multiple sclerosis: role of vitamin D and body mass index","volume":"21","author":"Yazdchi","year":"2022","journal-title":"Curr J Neurol"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12883-018-1113-5","article-title":"Sleep quality, daytime sleepiness, fatigue, and quality of life in patients with multiple sclerosis treated with interferon beta-1b: results from a prospective observational cohort study","volume":"18","author":"Kotterba","year":"2018","journal-title":"BMC Neurol"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1080\/15402002.2017.1342167","article-title":"Insomnia symptoms, subjective appraisals, and fatigue: a multiple mediation model","volume":"17","author":"Hare","year":"2019","journal-title":"Behav Sleep Med"},{"key":"ref63","first-page":"135","article-title":"Symptomatic fatigue in multiple sclerosis","volume":"65","author":"Freal","year":"1984","journal-title":"Arch Phys Med Rehabil"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"20552173231194352","DOI":"10.1177\/20552173231194352","article-title":"Sleep disturbance and fatigue in multiple sclerosis: a systematic review and meta-analysis","volume":"9","author":"Bhattarai","year":"2023","journal-title":"Mult Scler J"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1080\/09540261.2017.1322555","article-title":"Depression in multiple sclerosis","volume":"29","author":"Patten","year":"2017","journal-title":"Int Rev Psychiatry"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1016\/j.ncl.2012.08.018","article-title":"Psychiatric disorders and sleep","volume":"30","author":"Krystal","year":"2012","journal-title":"Neurol Clin"},{"key":"ref67","first-page":"553","article-title":"Sleep deprivation: impact on cognitive performance","volume":"3","author":"Alhola","year":"2007","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s00415-016-8318-6","article-title":"The role of sleep on cognition and functional connectivity in patients with multiple sclerosis","volume":"264","author":"van Geest","year":"2017","journal-title":"J Neurol"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1186\/s12888-024-06103-5","article-title":"Sleep and cognitive outcomes in multiple sclerosis; a systematic review","volume":"24","author":"Golabi","year":"2024","journal-title":"BMC Psychiatry"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1007\/s11910-018-0809-7","article-title":"Sleep disturbance and cognitive dysfunction in multiple sclerosis: a systematic review","volume":"18","author":"Hughes","year":"2018","journal-title":"Curr Neurol Neurosci Rep"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1563041\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T04:11:51Z","timestamp":1745986311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1563041\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,30]]},"references-count":70,"alternative-id":["10.3389\/fneur.2025.1563041"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1563041","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,30]]},"article-number":"1563041"}}